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PubMed2001

Psychiatric disorders in cancer patients: descriptive analysis of 1721 psychiatric referrals at two Japanese cancer center hospitals.

BACKGROUND: Although a diagnosis of cancer today may no longer be considered to be the equivalent of a death sentence, many previous studies in Western countries have revealed that such a diagnosis places many kinds of emotional burden on a patient. However, few studies have focused on the nature of psychiatric disorders in Japanese cancer patients. METHODS: We investigated the characteristics, reason for psychiatric consultation and psychiatric diagnosis of cancer patients by analyzing the database of patients referred to the Psychiatry Divisions at the National Cancer Center Hospital and the National Cancer Center Hospital East, Japan. RESULTS: Among a total of 1721 referrals, most of the cancer patients (78%) were inpatients. Patients with lung cancer (19%) were the most common, followed by patients with breast cancer (13%) and with head and neck cancer (10%). More than half of the patients had recurrent and/or metastatic cancer and 60% of the patients had pain. The most common reason for the consultation was psychiatric evaluation (35%), followed by sleep disorders (19%), anxiety or fear (18%) and depression (18%). Regarding the psychiatric diagnosis, adjustment disorders were the most common (34%), followed by delirium (17%) and major depression (14%). The diagnosis of cancer had been disclosed to more than 99% of the patients. CONCLUSION: The common psychiatric disorders observed in Japanese cancer patients were similar to those in the Western countries provided the cancer diagnosis is disclosed.

Adolescent↗
PubMed1989

Stability and natural history of DSM-III childhood diagnoses.

Follow-up or natural history outcome data for various DSM-III child and adolescent psychiatric diagnoses are presented. The data are relevant not only to our understanding of the specific disorders but also to the validity of the DSM-III diagnostic categories. "Semi-blind" psychiatric evaluations of 151 children were made as they presented to a community speech/language clinic and again approximately 4 years later. The follow-up data revealed high stability for only three diagnoses: infantile autism, attention deficit disorder with hyperactivity, and oppositional disorder. The data revealed that several of the DSM-III subcategories lacked predictive validity. This was true for the distinctions between attention deficit disorder with versus without hyperactivity; and between avoidant, separation anxiety, and overanxious disorders. Surprisingly low stability was found for conduct disorder diagnoses as were surprisingly poor prognoses for parent-child problems and adjustment disorders.

Adolescent↗
PubMed1990

Mental illness and religious change.

Over the last 20 years there has been a revival of interest in orthodox Judaism in Israel. In an area of Jerusalem with a large concentration of academies of study for 'baalei teshuva' (those who have undergone change to orthodox Judaism), it was noted that 12.6 per cent of referrals to the community mental health centre were newly religious. These referrals tended to have schizophrenia or severe personality disorders and were less likely than other referrals to have anxiety, depressive or adjustment disorders. Most of the newly religious referrals had psychiatric problems prior to becoming religious. Subsequent to religious change, many married and started a family before their psychiatric referral. The link between religious change and mental illness is explored.

Adaptation, Psychological↗
PubMed2001

[Psychosomatic dermatology - state of the art].

Based on the current literature, the paper gives an overview of the state of knowledge in psychosomatic dermatology. The authors propose the following classification: (1.) Dermatologic problems as a consequence of psychic disorders (e.g. factitious disorder, trichotillomania, dysmorphophobia, delusions of parasitosis etc.); (2.) Multifactorial dermatologic disorders, which can be substantially influenced by psychological factors (e.g. atopic dermatitis, psoriasis, chronic urticaria etc.); (3.) Psychic disorders developing as a consequence of disfiguring or life-threatening dermatoses (e.g. adjustment disorder, depressive disorder, anxiety disorder); (4.) Comorbidity with other psychiatric disorders. Psychosomatic dermatology developed from an anecdotal initial stage to more systematic research with larger numbers of patients, employing control groups and psychometric instruments. During the last decade, research focused on psychophysiological and psychoneuroimmunological mechanisms which influence dermatologic disorders. This course of development and the current state of knowledge are presented for atopic dermatitis and psoriasis.

Anxiety Disorders↗
PubMed1990

The diagnosis and treatment of adolescent anxiety disorders.

In adolescents, anxiety disorders may be manifested as juvenile anxiety syndromes, adult anxiety syndromes, or an adjustment disorder with anxious mood. In addition, depressive illnesses and attention-deficit hyperactivity disorder often exist comorbidly with the primary anxiety disorder. The treatment of anxiety in adolescents should be multimodal, including psychotherapeutic and psychosocial interventions along with pharmacotherapy. Tricyclic antidepressants and monoamine oxidase inhibitors have been successful in most anxiety disorders, although both classes of drug are associated with significant adverse effects and require careful monitoring. Benzodiazepines are effective in juvenile anxiety disorders. Clonazepam's long duration of action and relatively benign side-effects profile make it an attractive agent in adolescent populations.

Adolescent↗
PubMed1985

Pain as a symptom in elderly depressed patients. Relationship to diagnostic subgroups.

The presence of pain as a symptom has been studied in a series of 51 depressed elderly inpatients and in a control group of 71 subjects. The frequency of patients with moderate to severe pain was significantly higher in the experimental group (72%) than in the controls (33.8%). Of the various categories diagnosed according to the DSM III degree criteria, the highest scores for pain were gained by the subjects suffering from dysthymic disorder and atypical depression, while those obtained by the patients with major depression and adjustment disorder with depressive mood were lower. The difference does not seem to depend on the quantity of anxiety present.

Aged↗
PubMed1996

Outpatient mental health care in nonhospital settings: distribution of patients across provider groups.

OBJECTIVE: A national overview of outpatient mental health care in nonhospital settings is provided, focusing on the distribution of patients among psychiatrists, psychologists, general medical physicians, and other health professionals. METHOD: Data from the household section of the 1987 National Medical Expenditure Survey were analyzed to determine the volume and characteristics of patients receiving mental health care from these four professional groups. RESULTS: In 1987 an estimated 4.1% of noninstitutionalized Americans (9.0 million) made 84 million outpatient mental health visits to nonhospital settings. Psychiatrists provided significantly more visits than psychologists for schizophrenia, bipolar disorder, substance abuse, and depression, but significantly fewer visits for anxiety disorders and symptoms such as "nervousness." General medical physicians provided the most visits for adjustment disorders and substance abuse, while the other professionals provided the most visits for childhood mental disorders and mental retardation. CONCLUSIONS: In 1987 important differences existed between the outpatients who received mental health care from psychologists, psychiatrists, general medical physicians, and other health professionals.

Adolescent↗
PubMedDate not supplied

Memory complaint, memory performance, and psychiatric diagnosis: a community study.

This study examined the prevalence of memory complaint and poor memory performance on brief screening measures within a community sample of 810 adults. All individuals received an extensive household interview and a clinical psychiatric evaluation. Overall, 22% indicated that they currently had trouble with their memory. This percentage increased with age, rising to 43% for those 65 to 74 years old, 51% for those 75 to 84 years old, and 88% for those 85 years of age and older; the percentage indicating memory problems decreased with educational attainment. The prevalence of poor memory performance was 11%, also increasing with less education and increased age, rising to 26% for those 65 to 74 years old and to 40% for those older then 75. Those who complained of memory trouble were twice as likely to show poor memory performance (29%) compared with those who did not complain (15%). Multivariate analysis found age, emotional distress, and physical illness to be independent predictors of memory complaint; age, functional disability, education, and physical illnesses proved to be independently associated with poor memory performance. A higher prevalence of complaints of memory trouble was found not only for those with affective disorders, as might be expected, but also among those with schizophrenic, cognitive, anxiety, and adjustment disorders. However, only individuals with cognitive disorders showed a higher prevalence of poor memory performance.

Adolescent↗
PubMed2004

Incidence of psychiatric disorders after extended residence in Antarctica.

OBJECTIVES: The incidence of psychiatric disorders and depressive symptoms was examined in a cohort of American men and women who spent an austral winter at two different research stations in Antarctica to determine whether extended residence of nonindigenous inhabitants in a polar region is associated with psychiatric morbidity. STUDY DESIGN: Debriefings interviews with 220 men and 93 women were conducted by 3 psychiatrists and 1 clinical psychologist at McMurdo Station and South Pole Station at the end of the austral winter between 1994 and 1997. Crewmembers were assigned a DSM-IV diagnosis if they satisfied diagnostic criteria. Debriefed crewmembers also completed the Structured Interview Guide for the Hamilton Depression Inventory-Seasonal Affective Disorders version (SIGH-SAD). RESULTS: Thirty-nine (12.5%) crewmembers presented with symptoms that met the criteria for one or more DSM-IV disorders. After weighting the prevalence to account for the low participation rate of civilian personnel, the incidence of DSM-IV disorders was 5.2%. Mood disorders were the most common diagnoses, accounting for 30.2% of all diagnoses, followed by adjustment disorders (27.9%), sleep-related disorders (20.9%), personality disorders (11.6%), and substance-related disorders (9.3%). Depressive symptoms as measured by the SAD-SIGH were significantly associated with female gender, military occupation, station, year of expedition, and DSM-IV diagnosis. CONCLUSION: Differences in the distribution of symptoms and diagnoses by demographic and expedition characteristics suggests that the social environment may be a more powerful determinant than the physical environment of psychiatric disorders in a polar region.

Adult↗
PubMed2001

Potential clients' beliefs about the relative competency and caring of psychologists: implications for the profession.

To assess the extent to which the results reported by Warner and Bradley (1991) can be generalized beyond the population of undergraduate psychology students, 132 adults in the metropolitan Harrisburg area were asked to evaluate the competency and traits of clinical psychologists, licensed professional counselors, and psychiatrists. Results indicated that the general public believed counselors to be more caring than psychologists and psychiatrists. All three professional groups were perceived to be comparable in their ability to treat the least severe disorders. Licensed counselors were perceived to be most competent to treat disorders rated by the subjects as moderately severe, comparable in competence to clinical psychologists for adjustment disorders, and comparable to psychiatrists for marital problems. Psychiatrists and psychologists were considered the most competent to treat the most severe disorder, major depression. The results indicate that while clinical psychologists often were viewed as competent, they were not viewed as the single practitioner of choice for any diagnostic classification, nor were they noted to have positive character traits.

Adolescent↗
PubMed2001

Assessment of post-traumatic stress disorder and comorbidity.

The symptoms of lifetime post-traumatic stress disorder (PTSD) and comorbid diagnoses were compared among 502 combat-experienced soldiers under examination for compensation-related purposes to confirm or deny the diagnosis of PTSD and 196 soldiers with combat experience without any psychiatric disorder. The two groups were matched with regard to duration of combat experience, time between combat experience and the study, age, marital status, and education. PTSD was diagnosed by psychiatrists with a structured clinical interview according to the research version of the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders. The psychologists applied the Mississippi Scale for Combat-Related PTSD, Watson's criteria for PTSD, the Minnesota Multiphasic Personality Inventory version 201, and the Trauma Questionnaire. Also, a very detailed heteroanemnestic questionnaire was completed by social workers. Medical documentation and data from the combat services were provided during the examination for compensation-related purposes. After psychiatric and psychological assessment, 20% of the combat-experienced soldiers under examination for compensation-related purposes were diagnosed with lifetime PTSD, 47% were diagnosed with PTSD and comorbid disorders, 6% were diagnosed with PTSD and enduring personality change, and 5% were diagnosed with adjustment disorder. Twelve percent did not fulfill any diagnostic psychiatric criteria, and 10% fulfilled diagnostic criteria for other psychiatric disorders, although they had previous medical documentation confirming PTSD diagnoses. Correlation coefficients between psychiatric and psychological assessment were significant, indicating their complementarity in reaching the final diagnosis. It is necessary to include many different assessment methods in the examination for forensic or compensation-related purposes to obtain a more objective assessment.

Adult↗
PubMed2001

Prevalence of psychotic disorder and community level of psychotic symptoms: an urban-rural comparison.

BACKGROUND: Urban and rural populations have different rates of psychotic illness. If psychosis exists as a continuous phenotype in nature, urban-rural population differences in the rate of psychotic disorder should be accompanied by similar differences in the rate of abnormal mental states characterized by psychotic or psychosislike symptoms. METHODS: A random sample of 7076 individuals aged 18 to 64 years were interviewed by trained lay interviewers with the Composite International Diagnostic Interview. Approximately half of those with evidence of psychosis according to the Composite International Diagnostic Interview were additionally interviewed by clinicians. We investigated associations between a 5-level urbanicity rating and (1) any DSM-III-R diagnosis of psychotic disorder (sample prevalence, 1.5%), (2) any rating of hallucinations and/or delusions (sample prevalence, 4.2%), and (3) any rating of psychotic or psychosislike symptoms (sample prevalence, 17.5%). RESULTS: Level of urbanicity was associated not only with DSM-III-R psychotic disorder (adjusted odds ratio [OR] over 5 levels, 1.47; 95% confidence interval [CI], 1.25-1.72), but also, independently, with any rating of delusion and/or hallucination (adjusted OR, 1.28; 95% CI, 1.17-1.40; clinician-assessed psychotic symptoms only: OR, 1.30; 95% CI, 1.03-1.64) and any rating of psychosislike symptom (adjusted OR, 1.18; 95% CI, 1.13-1.24). Psychotic symptoms were strongly and independently associated with psychotic disorder, regardless of the level of urbanization. CONCLUSIONS: Community level of psychotic and psychosislike symptoms may be inextricably linked to the prevalence of psychotic disorder. The prevalence of abnormal mental states that facilitate development to overt psychotic illness increases progressively with level of urbanization.

Adolescent↗
PubMed2004

Mental health in prison populations. A review--with special emphasis on a study of Danish prisoners on remand.

OBJECTIVE: To review the literature on mental health and psychiatric morbidity in prison populations and relate findings to a Danish study on remand prisoners. METHOD: The literature is reviewed and subdivided in the following section: validity of psychometrics in prison populations, prevalence of psychiatric disorders prior to imprisonment, incidence of psychiatric disorders during imprisonment, psychopathy related to psychiatric comorbidity, dependence syndromes with special emphasis on different administrations of heroin use (smoke vs. injection). The results are compared with a longitudinal Danish study on remand prisoners in either solitary confinement (SC) or non-SC. RESULTS: Many factors must be taken into consideration when dealing with prisoners and mental health, e.g. international differences, the prison setting, demographics and methodological issues. The prison populations in general are increasing worldwide. Psychometrics may perform differently in prison populations compared with general populations with the General Health Questionnaire-28 having a low validity in remand prisoners. Psychiatric morbidity including schizophrenia is higher and perhaps increasing in prison populations compared with general populations with dependence syndromes being the most frequent disorders. The early phase of imprisonment is a vulnerable period with a moderately high incidence of adjustment disorders and twice the incidence in SC compared with non-SC. Prevalence of psychopathy is lower in European than North American prisons. Medium to high scores of psychopathy is related to higher psychiatric comorbidity. Opioid dependence is the most frequent drug disorder with subjects using injection representing a more dysfunctional group than subjects using smoke administration. Many mentally ill prisoners remain undetected and undertreated. CONCLUSION: There is a growing population of mentally ill prisoners being insufficiently detected and treated.

Adult↗
PubMed1994

Belief in demons and exorcism in psychiatric patients in Switzerland.

Belief in demons as the cause of mental health problems is a well-known phenomenon in many cultures of the world. However, there is little literature on this phenomenon in Protestant subcultures of the West. The author conducted a systematic investigation of the prevalence of this attribution in 343 mainly Protestant out-patients of a psychiatric clinic in Switzerland, who described themselves as religious. Of these, 129 (37.6 per cent) believed in the possible causation of their problems through the influence of evil spirits, labelling this as 'occult bondage' or 'possession'. One hundred and four patients (30.3 per cent) sought help through ritual 'prayers for deliverance' and exorcism. Prevalence of such practices was significantly related to diagnosis (p < .01) and to church affiliation (p < .005). Patients in charismatic free churches suffering from anxiety disorders and schizophrenia reported the highest rate of exorcistic rituals (70 per cent), and patients with adjustment disorders from traditional state churches the lowest (14 per cent). The various forms and functions of these healing rituals are described. Although many patients subjectively experienced the rituals as positive, outcome in psychiatric symptomatology was not improved. Negative outcome, such as psychotic decompensation, is associated with the exclusion of medical treatment and coercive forms of exorcism.

Adult↗
PubMed2005

A 3-year panel study of mental disorders among adolescents in Taiwan.

OBJECTIVE: This study investigated the prevalence and changing trends of mental disorders and the effects of gender and urbanization among adolescents in Taiwan. METHOD: A random sample of seventh-grade students (N=1,070) was recruited from one urban and one rural junior high school in which 1,051 (98.2%) and 1,035 (96.7%) were reassessed in the second and third years, respectively. A two-stage case identification was conducted by mental health professionals with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version, supplemented by information from the Child Behavior Checklist. RESULTS: The weighted 3-month prevalence rates across the 3 consecutive years for overall psychiatric disorders were 20.3%, 22.7%, and 14.8%, respectively. The most prevalent psychiatric condition was attention deficit hyperactivity disorder (ADHD) in the first 2 years and substance use disorders in the third. During the 3 years, the rates for ADHD, specific phobia, and social phobia decreased, and the rates for major depression and substance use disorders, conversely, increased. Although conduct disorder, ADHD, and substance use disorders were more prevalent among boys, the rates for major depression, social phobia, specific phobia, and adjustment disorder were higher among girls. Rural adolescents had higher rates of conduct disorder, oppositional defiant disorder, and substance use disorders than their urban counterparts. CONCLUSIONS: Our findings are similar to those of previous studies among adolescents in prevalence rates, changing trends of most mental disorders, and gender effects. The differential changing trends in various diagnostic groups may imply the importance of specific measures for prevention during adolescence.

Adolescent↗
PubMed2004

[Clinical analysis and demographic characteristics of the sample of patients from the psychiatric outpatient clinic for chiidren and adolescents].

The article presents the demographic and clinical analysis of the sample of 679 persons in age under 20 who were out-patients in the Clinic of Child and Adolescent Psychiatry in Cracow (Poland) during one year. The clinical analysis takes into account among others the structure of diagnoses set according to ICD-10, the presence of additional diagnoses and risk factors, the way patients were referred to the out-patient units, and the sort of the care proposed. Most often syndromes from the section of emotional and behavioral disorders of childhood and adolescence (F90 - F98 in ICD-10) were recognised. On the level of separate disorders most popular in adolescents were anorexia nervosa (16%), adolescent depression (10%), acute psychoses (8%), and adjustment disorder (8%). In the discussion the results were referred to epidemiological community studies. It has been also noticed that the way symptoms of adolescence are understood is essential in psychiatric evaluation of adolescents.

Adolescent↗
PubMed1986

DSM-III diagnoses in Social Security disability applicants referred for psychiatric evaluation.

Demographic data and DSM-III diagnoses are presented for 55 applicants for Social Security disability benefits who were referred for psychiatric evaluations of psychiatric disability. Some of the applicants had apparently experienced difficulties in functioning secondary to severe psychiatric disorders (schizophrenic and schizoaffective disorders, 27%; anxiety disorders, 15%; and affective disorders, 33%), and others had psychiatric problems that may have been secondary to adverse life circumstances (adjustment disorders, 6%; phase-of-life problems, 6%; and bereavement, 2%); some of the affective disorders may also have been precipitated by environmental events. Many of the psychiatric disorders were potentially treatable (affective, anxiety, and substance abuse disorders).

Adult↗
PubMed2002

Depressive spectrum disorders in high-risk adolescents: episode duration and predictors of time to recovery.

OBJECTIVE: Durations of first episodes of major depression, dysthymia, adjustment disorders with depressed mood or with mixed emotional features, and minor depressions were examined in a community high-risk adolescent sample. Factors associated with longer recovery times were examined for each disorder. METHOD: Semistructured diagnostic interviews were conducted annually (6th through 12th grade) to assess children's current and lifetime history of psychopathology. Cox regressions were used to explore factors associated with longer time to recovery. RESULTS: Episode durations were consistent with prior community studies and generally shorter than those reported in clinical samples. A greater number of maternal depressive episodes predicted a more prolonged time to recovery from major depression, and greater adolescent impairment was associated with longer episode duration of both major and minor depression. CONCLUSIONS: Treatment and prevention efforts should be directed toward offspring of parents with recurrent mood disorders, particularly adolescents with minor as well as major depression. The authors also recommend that the median rather than the mean be used to evaluate the duration of depressive disorders.

Adolescent↗